Human Resource Department

Human Resource Department
14515 S. Veterans Drive
Somerton, Arizona 85350
(928) 627-2102 ext. 7428
Fax: (928) 722-7618
e-mail: [email protected]
Thank you for taking the time to consider employment with the Cocopah Indian Tribe.
Please remember these important details when completing your application:
1. Complete the application using legible blue or black ink.
2. Include which location you are applying for.
3. Make sure you include your Mailing Address in the application.
4. Please answer all questions openly and honestly
5. Provide accurate addresses, telephone numbers, and dates of employment and supervisors
for each job listed on your application.
6. LEAVE NOTHING BLANK! “See Resume” is not ACCEPTABLE.
7. Sign your application.
8. Include a copy of your high school diploma/GED or college degree(s) confirming your
highest level of education. Also include any job specific certifications or licenses.
Previous education and work experience will be verified on all top candidates being considered
for employment at Cocopah Indian Tribe. Having the above information is imperative to
properly determine each applicant’s qualifications for a specified job vacancy.
Thank you,
The Cocopah Indian Tribe
Human Resource Department
KEEP THIS PAGE FOR INFORMATION ONLY.
Incomplete or False Information is cause for rejection or dismissal of application.
Cocopah Government
Cocopah Casino (Must be 21 yrs. of age to apply at the Casino)
Cocopah Resort & Conference Center
Wild River Family Entertainment Center
Cocopah Bend RV & Golf Resort
Cocopah Rio Colorado Golf Course
Cocopah Korner Store
14515 South Veterans Drive
Somerton, Arizona 85350
(928) 627-2102 ext. 7428
Fax: (928) 722-7618
e-mail: [email protected]
Employment Application
Applying for:
Date:
Name:
Last
First
Middle
(Former Last Name)
Address/Mailing:
City
Home Telephone:
State
Cell Phone:
Zip
e-mail:
Social Security No:
□Yes □No
Do you have a valid AZ Driver’s License?
Driver’s License No:
State:
Expiration Date:
Class:
CDL?
□Yes □No
Are you an enrolled member of any U.S. Federally recognized Tribe?
If yes, Tribe
□Yes □No
Enrollment Number
□Yes □No
Are you related to any current Cocopah Indian Tribe employee?
If ‘yes”, name and relationship?
Have you been convicted of, or plead guilty or no contest to, a felony; or received probation or
deferred adjudication when charged with a felony?
If “yes”, date
□Yes □No
City/State
Charge
Disposition
(Punishment/Sentence)
Have you previously worked or do you currently work for the Cocopah Indian Tribe?
Are you available to work:
□ full time
□ part time
□Yes □No
□ shift work □ temporary?
Days/Hours available:

EDUCATION
Did you receive High School Diploma
Name and City/State
□
GED
□
Institution:
Dates of
Attendance
Year:
Degree Received or
Course of Study
Graduate
High School or Equivalent
□ Yes □ No
College, University or Trade School
□ Yes □ No
College, University or Trade School
□ Yes □ No
College, University or Trade School
□ Yes □ No

EMPLOYMENT HISTORY
List all jobs (including military service) beginning with your MOST RECENT employer and the last 10 years of employment. Use
additional pages as necessary.
Employer
From
Address
To
Telephone
No, Street
City
Position Title
Duties
□ Full Time □ Part Time
State
Zip
Supervisor
Ending Salary
Reason for leaving?
(if military service, indicate type of discharge applicable) May we contact this employer?
Employer
□ Yes □ No
From
Address
To
Telephone
No, Street
City
Position Title
Duties
□ Full Time □ Part Time
State
Zip
Supervisor
Ending Salary
Reason for leaving?
(if military service, indicate type of discharge applicable) May we contact this employer?
Employer
□ Yes □ No
From
Address
To
Telephone
No, Street
City
Position Title
Duties
□ Full Time □ Part Time
State
Zip
Supervisor
Ending Salary
Reason for leaving?
(if military service, indicate type of discharge applicable) May we contact this employer?
Employer
□ Yes □ No
From
Address
To
Telephone
No, Street
City
Position Title
Duties
□ Full Time □ Part Time
State
Zip
Supervisor
Ending Salary
Reason for leaving?
(if military service, indicate type of discharge applicable) May we contact this employer?
□ Yes □ No
Have you ever been terminated or asked to resign from any job?
If yes, please explain circumstances:
□ Yes □ No
Please explain fully any gaps in your employment history

Skills and Abilities
List any position related licenses, registrations, certificates or professional memberships:
Check Skills/Equipment Operated
□ PC □ Fax □ MS Word
□ MS Excel
□ Ms Access
Are you legally authorized to work in the United States?
□ MS Power Point
Other:
□Yes □ No
Are you capable of satisfactorily performing the essential job duties of the position, with or without reasonable accommodation, for which you
are applying? (Please review the job description)
Yes
No
Do you have adequate transportation to and from work?

□
□
□ Yes □ No
Personal References
Please list at least three persons who know you well- not previous employers or relatives
Name
Occupation
Address
(Street, city and State)
Telephone Number
Years
Known
Applicant’s Statement & Agreement
Work Rules. In the event of my employment with the Cocopah Indian Tribe, I agree to comply with all rules and regulations of the Cocopah
Indian Tribe.
Drug /Alcohol Test. I understand that the Cocopah Indian Tribe reserves the right to require me to submit to a test for the presence of drugs and
alcohol in my system prior to employment and at any time during my employment to the extent permitted by law.
Background Investigation. I understand that the Cocopah Indian Tribe’s consideration of my application includes an investigation of the
information I have provided on this application and other relevant information such as my driving record and criminal record, if any. I
understand that should I decline to consent to such an investigation, my application for employment may be rejected or my employment may be
terminated.
At Will Employment If hired, I further agree as follows: My employment and compensation are terminable at will, are for no definite period, and
my employment and compensation may be terminated by the Cocopah Indian Tribe at any time and for any reason whatsoever, with or without
good cause at the option of either The Cocopah Indian Tribe or myself. This “At Will” relationship will remain in effect throughout my
employment with the Cocopah Indian Tribe, and cannot be modified by any oral or implied agreement. It may only be changed by an express,
written employment agreement, signed by you and the Tribal Chairperson, and approved by the Tribal Council.
I hereby certify that all the information that I have provided on this application or any other document filled out in connection with
employment, is true and correct. I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that if I am
employed and any such information is later found to be false or incomplete in any respect, I may be dismissed.
If you have any questions regarding this agreement, please ask a Tribal representative before signing.
Signature
(if submitting online, you can sign the application during your in-person interview)
Date
Voluntary Information
(Please print)
Date:
Government agencies at times require periodic reports on the sex, ethnicity, handicap, veteran and other protected
status of employees. This data is for statistical analysis with respect to the success of the Affirmative Action program.
SUBMISSION OF THIS INFORMATION IS VOLUNTARY
Name
Date of Birth
Address
City
State
Social Security Number

Zip Code
How did you hear about us?
□ Male
Check One:
□ Female
Check One of the Following Ethnic Origins:
□ White
□ Black

□ Hispanic
□ Other
□ American Indian/Alaskan Native
□ Asian/Pacific Islander
Military Record:
Branch of Service:
Status:
Type of Discharge:
Training received in Service related to this position:
Check if any of the Following are Applicable:
□ Vietnam Era Veteran
□ Disabled Veteran
□ Handicapped Individual
IN CASE OF EMERGENCY PLEASE CONTACT:
Name:
Relationship:
Address:
Phone Number:
Signature:
Date:
(if submitting online, you can sign the application during your in-person interview)
Submit